Mentioning public health problems might bring to mind tobacco use, heart disease and prescription drug overdoses. Just as serious, intimate partner violence (IPV) is a public health problem that affects millions of Americans.
As the healthcare professionals who are most involved with patients, nurses are uniquely positioned to lead violence prevention and intervention efforts. Understandably, RNs may lack confidence when it comes to addressing this complex issue.
Achieving higher levels of education can prepare RNs to care for patients who are affected by IPV. The RN to BS in Nursing online program at Fitchburg State University, for example, puts an emphasis on caring for forensic populations.
To understand an RN’s role in violence detection, prevention and intervention, it is helpful to get a sense of the scope of the problem. According to the Centers for Disease Control and Prevention (CDC), IPV was a recognized social problem in the 1960s and 1970s. In 1979, the Surgeon General’s Report identified 15 priority areas for public health. Violence prevention was one of them. Forty years later, intimate partner violence is recognized by the CDC as a “serious, preventable public health problem.”
The CDC defines IPV as “physical, sexual, or psychological harm by a current or former partner or spouse.” The CDC stresses that IPV can occur among heterosexual or same-sex couples and does not require sexual intimacy. IPV is more common than many people think:
- The National Domestic Violence Hotline reports that in the U.S. alone, more than 12 million individuals a year are victims of rape, physical violence or stalking by an intimate partner. That is 24 people per minute.
- The majority of IPV victims are women, though men also experience domestic violence.
- The National Domestic Violence Hotline reported more than half a million calls and online chats in 2018.
RNs are known for being trustworthy. This positions them to advocate for patients experiencing IPV. As Futures Without Violence advises, “Being there for a patient unconditionally is the goal.”
Patients experiencing IPV are often treated in emergency departments. However, they may not report IPV for many reasons, including:
- Fear for their safety
- Fear for the safety of family members
- Denial, shame and depression
- Hope that the perpetrator will change
- Lack of financial independence
- Distrust or a belief that nobody can help them
- Immigration status
Therefore, it is essential that RNs recognize the signs. Abrasions, bruising in the chest or abdomen, and broken teeth are common examples. But not all signs of IPV are this obvious.
The Emergency Nurses Association (ENA) points out that signs of strangulation can easily be missed. Yet, non-fatal strangulation in IPV is the “most predictive factor for subsequent severe violence.” According to the ENA, victims of one episode are eight times more likely to become a homicide victim of that current or former partner.
A joint statement by the ENA and the International Association of Forensic Nurses (IAFN) cites research indicating low screening rates for IPV. Contributing factors may include provider discomfort with “screening questions, positive disclosures, and safety planning.”
Compassion and respect for patients’ dignity and worth go hand in hand with nursing. This helps RNs build rapport with patients. In turn, patients may feel safer discussing IPV with their nurse.
Pursuing education on IPV can prepare RNs to provide the appropriate prevention and intervention.
It is said that knowledge builds power. For RNs, enhancing knowledge and skills related to IPV can make the difference between helping a patient and being one more person who avoids the issue altogether.
The course NURS 4520: Caring for Forensic Populations in Fitchburg State’s online RN to BS in Nursing program provides nurses with a foundation for preventing and reducing the consequences of domestic violence. Topics include:
- Individual, sociocultural, environmental and systemic factors related to violence and trauma
- Forensic health assessment
- Violence prevention and intervention strategies
Other courses that provide RNs with additional preparation to serve as advocates for vulnerable populations include NURS 3600: Health and Physical Assessment and NURS 4020: Social Justice and Advocacy.
In the foreword for a World Health Organization report on violence and health, Nelson Mandela wrote, “We owe our children — the most vulnerable citizens in any society — a life free from violence and fear. In order to ensure this, we must be tireless in our efforts not only to attain peace, justice and prosperity for countries, but also for communities and members of the same family.”
RNs comprise the largest healthcare occupation, and they provide the majority of patient care. Because of the high incidence of IPV, RNs will likely care for patients who experience IPV. By becoming informed about IPV, RNs can take a leading role in substantially improving health outcomes for their patients.
Learn more about Fitchburg State University’s online RN to BS in Nursing program.
Sources:
CDC: The History of Violence As a Public Health Issue
CDC: Violence Prevention – Intimate Partner Violence
The National Domestic Violence Hotline: Get the Facts & Figures
National Domestic Violence Hotline: A Year of Impact – 2018
FuturesWithoutViolence.org: A Call to Action: The Nursing Role in Routine Assessment for Intimate Partner Violence
Emergency Nurses Association: An Overview of Strangulation Injuries and Nursing Implications
Emergency Nurses Association: Intimate Partner Violence
World Health Organization: Violence and Injury Prevention
Home > Health and Safety > Additional Reading > Domestic Violence
The intentional violent or controlling behavior by a person who is currently, or was previously, in an intimate relationship with the survivor. It encompasses physical injury as well as intimidation, humiliation, fear, financial, emotional or sexual injury (MNA Domestic Violence Task Force, 1993).
MNA Domestic Violence Task Force Introduction
Safety in the home and workplace is being increasingly recognized as a public health concern. Health care workers are frequently involved with patients who have been or are experiencing domestic violence (DV). Domestic violence is likely to increase in frequency and severity over time, and the risk is greatest with a decision to leave the abusive situation.
Health care workers may also be affected by DV's existence among family members and friends, or by witnesses to violent episodes which spill over into the workplace with colleagues or patients. In addition, as a mostly female workforce, they themselves may be victimized by the problem. Thirty-eight% of women murdered by partners in 1998 were health care workers.
Who Are the Abused?
Domestic violence occurs in:
- up to 30% of all women at least once in their lifetime
- 30% of women seen in emergency rooms
- 25% of pregnant women
- 15% of women seen for general health care
- possibly 90% of disabled women
- 5-10% of victims are males
- 4% are same-sex relationships
- a high percentage of homeless women
- all racial groups at comparable rates
- every socioeconomic class
No One Is Immune
Recognition
Indicators of DV include but are not limited to:
- Physical injury
- Vague chronic complaints, fatigue
- Pelvic pain or GYN disorders
- Depression or substance abuse
- Eating or sleeping disorders
- Suicidal ideation
Abuser behaviors may include:
- Threats of injury or use of weapons
- Restriction on movement or activities
- Exposure to risks (reckless driving)
- Forced sexual activity or pregnancies
- Constant criticism or devaluing
- Extreme jealousy or possessiveness
- Over protectiveness
- Destruction of possessions
- Excessive financial control
- Limits on social and family contacts
- Harassment while at work
Interventions
Screening questions for DV include:
- Have you ever been emotionally abused, threatened, or controlled by your partner or someone important to you?
- Have you ever been in a relationship where you have been hit, slapped, kicked or otherwise physically hurt?
- Has anyone ever forced you to have sexual activities against your will?
- Does your partner ever make you feel afraid or scared?
- Do you feel safe at home?
Helpful behaviors include:
- Assessing own feelings about DV
- Preparing to respond to a disclosure
- Listening actively and objectively
- Believing the story
- Validating feelings and fears
- Making statements such as "Because DV is so common, I ask all my patients about it."
- Avoiding "why" questions such as "Why don't you leave?" "Why haven't you called the police?"
- Documenting history, symptoms, findings, evidence and photographs
- Assessing safety and lethality
- Are threats verbal/physical?
- Are weapons used or available?
- Is the violence becoming greater/more frequent?
- What is the worst thing ever done to you so far?
- Are your children threatened also?
- Is your partner jealous (scale: 1-10)?
- Mutually developing a safety plan
- Respecting a decision to stay or leave
- Accepting that lack of immediate "compliance" is not proof of provider failure
- Providing referrals to local resources: police, hotlines, shelters, counseling
- Educating everyone about DV
Keys to Reducing Domestic Violence
- Education
- Training health care workers
- Institutional policies and procedures
- Societal awareness
- Adequate community resources
Legal Interventions
Mandated Reporting
In Massachusetts, no law mandates reporting domestic violence. A victim has the right to decline to report an incident. A health care worker can assist the DV victim to report.
However, reporting is mandated under Massachusetts law when the victim is a minor, an elder, or disabled, or when there are stab wounds or gunshots, or burn injuries over 5% of the body. Other states laws may differ.
Contacts:
- Minor: DSS: 800.792.5200
- Disabled: 800.426.9009
- Elder: 800.922.2275
- Weapon Use: Local police
Felony Charges
Health care workers can be of great assistance to the DV survivor through verbatim recording of statements regarding threats or fear (assault) and photographic or body-map documentation of injuries (battery) that can be introduced in court to support allegations of DV. Felony charges can be sought by the police or by the survivor.
Restraining Orders
Survivors of DV may seek emergency, temporary or permanent restraining orders against the abuser through Superior, Probate, Family, District or Municipal Courts. These range from orders to refrain from further abuse, to avoid any contact with the survivor, to provide financial support or funding for losses suffered, or to give up custody of children. DV survivors need to be aware that restraining orders can be ignored, and have led to escalation of violence and even death.
Community Interventions
Counseling
No one deserves to be abused. Many survivors of DV need help in regaining their sense of self-worth. Mental health providers in community health centers and medical facilities can be helpful in promoting self-esteem and in assisting the victim to assess risk and develop a long-term safety plan.
Shelters
There are two types of shelters for survivors of domestic violence: homeless residences for those who do not wish to return to their homes but lack the resources to obtain another residence, and battered women's shelters which are anonymous residences for those fearing reprisal. Often it is safer to use a geographically distant residence. Child care when leaving the home complicates shelter issues. Shelters differ on accepting children (particularly male teenage children) or pets.
Societal Interventions
Health care workers also have a responsibility to influence societal attitudes toward domestic violence. As PTA members, church congregants, community participants or leaders, social club members and voters, they can be proactive in supporting social, economic or political changes to assist DV survivors in moving beyond their present situation.
MNA's Domestic Violence Task Force has a Speakers' Bureau available for professional or community presentations on DV.
They may be contacted at 781.821.4625.
Workplace
Employee Assistance Programs (EAPs) are the most common source of workplace assistance for counseling and referral to resources. Occupational health nurses may also be of assistance. Some employers have been proactive in direct provision for worker safety such as security pagers, compliance with restraining orders, confidentiality efforts, camera surveillance, and staggered working hours.
Employers Against Domestic Violence (617.348.4970) is a Massachusetts group which educates employers, helps by critiquing workplace DV policies and identifies best practices. Employees might suggest that their employer ask them for assistance. Many health care agencies have domestic violence committees who have developed policies about DV for both patients and employees.
Information & Referral Sources
Federal, State and Local Agencies
National 24-hr hotline | 800.799.SAFE TTY#: 800.787.3224 |
MA State-wide 24-hr hotline | 800.992.2600 |
MA Battered Women's Coalition | 617.661.7203 |
Network for Battered Lesbians & Bisexual Women | 617.423.7233 |
Gay Men Against Domestic Violence | 800.832.1901 |
Brockton Family and Community Resources | 508.583.5200 |
New England Learning Center for Women in Transition (Athol) | 888.249.0806 |
Shelters/Other Services
Greater Boston:
Boston | Asian Task Force Against Domestic Violence | 617.338.2355 |
Boston | Casa Myrna Vasquez | 800.992.2600 |
Cambridge | Transition House | 617.661.7203 |
Chelsea | Harbor Cove | 617.884.9909 |
Jamaica Plain | Elizabeth Stone House | 617.522.3417 |
Jamaica Plain | F.I.N.E.X. House | 617.288.1054 |
Lawrence | Women's Resource Center | 800.400.4700 |
Lowell | Alternative House | 978.454.1436 |
Malden | Services Against Family Violence | 781.324.2221 |
Roxbury | Renewal House | 617.566.6881 |
Somerville | Respond | 617.623.5900 |
Quincy | DOVE Shelter | 617.471.1234 |
Northern MA: | ||
Newburyport | Women's Crisis Center | 978.465.2155 |
Salem | Healing Abuse Working for Change (HAWC) | 800.547.1649 |
Central MA: | ||
Framingham | Women's Protective Service | 508.626.8686 |
Newton | Second Step Inc. | 617.965.3999 |
Waltham | Support for Battered Women | 800.899.4000 |
Worcester | Abby's House | 508.756.5486 |
Worcester | YWCA Daybreak | 508.755.9030 |
Southern Worcester County | New Hope | 800.323.4673 |
Western MA: | ||
Amherst | Everywomen's Center | 888.837.0800 |
Greenfield | NELCWIT | 978.772.0806 |
Holyoke | Women's Shelter/Companeras | 413.536.1628 |
Leominster | Battered Women's Resources | 877.342.9355 |
Northampton | Necessities/Necesidades | 413.586.5066 |
Pittsfield | Elizabeth Freeman Center | 413.443.0089 |
Westfield | New Beginnings/YWCA | 800.479.6245 |
Southeastern MA: | ||
Attleboro | New Hope | 800.323.4673 |
Brockton | Woman's Place Crisis Center | 508.588.2041 |
Fall River | S STAR | 508.675.0087 |
Fall River | Our Sisters' Place | 508.677.0224 |
New Bedford | The New Bedford Women's Center | 888.839.6634 |
Cape Cod & Islands: | ||
Plymouth | South Shore Women's Center | 508.746.2664 |
Hyannis | Independence House | 800.439.66507 |
North Falmouth | The Cape Cod Center for Women | 508.564.7233 |
Nantucket | A Safe Place | 508.228.2111 |